Substance Dependence Criteria

A maladaptive pattern of substance use,
leading to clinically significant impairment or
distress, as manifested by three (or more) of
the following, occurring at any time in the
same 12-month period:
• tolerance, as defined by either of the
following:
– a need for markedly increased amounts
of the substance to achieve intoxication
or desired effect, or
– markedly diminished effect with continued
use of the same amount of the
substance
• withdrawal, as manifested by either of the
following:
– the characteristic withdrawal syndrome
for the substance, or
– the same (or closely related) substance is
taken to relieve or avoid withdrawal
symptoms
• the substance is often taken in larger
amounts or over longer period than was
intended
• there is a persistent desire or unsuccessful
efforts to cut down or control substance use
• a great deal of time is spent in activities
necessary to obtain the substance (e.g.,
visiting multiple doctors or driving long
distances), use the substance (e.g., chainsmoking),
or recover from its effects
• important social, occupational or recreational
activities are given up or reduced
because of substance use
• the substance use is continued despite
knowledge of having a persistent or
recurrent physical or psychological problem
that is likely to have been caused or exacerbated
by the substance (e.g., current
cocaine use despite recognition of cocaine induced
depression, or continued drinking
despite recognition that an ulcer was made
worse by alcohol consumption)

Treatment Plan
The written treatment plan should state
objectives that will be used to determine
treatment success, such as freedom from
intoxication, improved physical function,
psychosocial function and compliance and
should indicate if any further diagnostic
evaluations are planned, as well as counseling,
psychiatric management or other ancillary
services. This plan should be reviewed
periodically. After treatment begins, the
physician should adjust drug therapy to the
individual medical needs of each patient.
Treatment goals, other treatment modalities
or a rehabilitation program should be evaluated
and discussed with the patient. If
possible, every attempt should be made to
involve significant others or immediate family
members in the treatment process, with the
patient’s consent. The treatment plan should
also contain contingencies for treatment
failure (i.e., due to failure to comply with the
treatment plan, abuse of other opioids, or
evidence that the Schedules III-V medications
are not being taken).